Despite modest reductions in mortality over the past decade, the burden of maternal and early childhood death in Zambia remains among the highest in the world. In this application, we seek to improve maternal and child outcomes in Lusaka Province by enhancing specialty training for obstetric and neonatal care at the University of Zambia School of Medicine. Referral services are critically needed for the timely treatment of complications and must be strengthened alongside community-based initiatives to improve maternal and child health. We describe our medical education initiative in the context of four specific aims. First, we will enhance training through novel approaches in medical education, including patient-encounter simulations, team-based skills training, emergency drills, and faculty engagement. Second, we will standardize and improve clinical care by implementing medical guidelines and ensuring their adherence through regular perinatal audits. Third, we will expand our medical education model to community-based nurse and midwife training, integrating our patient-encounter simulations into emergency obstetrical care, neonatal resuscitation, and essential newborn care. Finally, to assess the impact of these interventions, we will develop a framework for program evaluation and outcomes research, focusing on comprehensive surveillance of maternal and early childhood mortality. This emphasis on patient outcomes is a unique feature of our program and will provide value information to inform the cost-effectiveness and sustainability of our interventions. To accomplish these aims, we have assembled a strong team of clinician-educators and physician-scientists from three principal institutions: the University of Zambia, the Centre for Infectious Disease Research in Zambia, and the University of Alabama at Birmingham. By working within the administrative structure of UNZA's MEPI award, we substantially leverage these funds to address a well- established global health priority - making pregnancy and delivery safer - and to provide the framework for future health improvements across Zambia. PUBLIC HEALTH RELEVANCE: The risk of death during pregnancy and around delivery remains unacceptably high worldwide. While many have sought to expand access of services at the community level, such efforts must be accompanied by enhancements in facility-based care. This application seeks to improve the quality of clinical care and training at one tertiary care facility in Zambia and demonstrate its impact on population-level outcomes.